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Monday, July 25, 2011

Nails: more than just "Manies and Pedies"

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When I was a medical student, we studied for two years in the basic sciences before ever setting foot on the "wards": needless to say, when we first went into the hospital - following on after the Consultant like a flock of white goslings - we tried to soak up everything we could. One of the first mysteries presented to me was the habit of every senior Doctor to pick up the patients hand and stare at it for a few seconds, before even looking at the patients notes. This happened even if the patient was a heart patient, had lung problems, was missing a leg or unconscious, was 8 months or 88 years old: every last patient examination started with the hand.

Well, the hand can tell you a lot about what may be wrong, or right, with a patient: and even the nails can provide clues to the the individuals health, and not just about their social status! Here are some of the things that Doctors look for:

Nail Clubbing-1

Clubbing: about 80% of cases occur with heart and lung diseases.

Pitting of the nails - Psoriasis -2

Psoriasis: This is a common skin condition but will often affect the nails: psoriasis can vary from the mild form (as in the illustration) with simple pitting of the nails; to severe destruction of the nails with thick layers of psoriatic skin building up underneath the nail bed, leading to gross nail deformities. Psoriasis can also lead to a form of arthritis.

Fungal fingernails -3

Infections:

Fungal infections are more common on the toenails, but can be found in the fingernails, especially in Diabetics and those on steroids for various diseases.

Bacterial infections are more common in fingernails due to trauma or biting of the nails.

Viral infections may occur (commonly called a Whitlow, although Orf is another viral nail infection, a disease found in sheep and goats which can be transmitted to humans), and like bacterial infections, tend to happen around the nail and are often very painful.

Cyanosis of the nails

Cyanosis: this is a bluish discoloration of the nails and suggest low levels of oxygen in the blood: a common cause for this is lung disease. In a hospital setting this can be rapidly confirmed by blood gas analysis.

These are just some of the nail manifestations of what may be a widespread clinical problem: the list includes white nails, brittle nails, ridged nails and in many young people, bitten nails: but then, not everything that looks a bit ugly need be a cause for concern.